Factors Associated with 30-day Unplanned Readmissions of Sepsis Patients: A Retrospective Analysis of Patients Admitted with Sepsis at a Community Hospital.

Abstract

IntroductionMortality from sepsis is decreasing in recent years owing to improved quality of care, targeted programs, and the implementation of sepsis bundles. This has led to an increased pool of sepsis survivors at risk of readmissions. Studies have shown that these sepsis readmissions are common and expensive. The factors associated with these readmissions remain elusive and have incited a lot of research in recent years. The 30-day sepsis readmission rate is increasingly being used as a quality metric for hospitals. A conducted a retrospective chart review analysis of patients admitted with sepsis to find factors affecting the 30-day readmissions of sepsis survivors.MethodsPatients admitted to our hospital either on the medical-surgical floor or in the intensive care unit (ICU) with an administrative coding for sepsis between January 2014 to November 2015 were identified. A literature search, as well as expert opinion, was considered for the list of factors to be studied, including age, sex, residence on admission, length of stay, getting hemodialysis, hospitalization in the prior year, presence of acute kidney injury (AKI), source of sepsis, discharge disposition, receipt of red blood cell (RBC) products, and route of antibiotics on discharge. A univariate binary logistic regression analysis was performed to test the association between the above-mentioned variables and sepsis readmission. Variables with statistical significance in the univariate analysis were used to compute the multivariate regression analysis along, with adjusted OR and their 95% CI.ResultsA total of 1297 patients were identified with sepsis. Of these, 1068 patients met inclusion criteria. The readmission rate in our study population was 19.19%, and 52% of the readmissions were secondary to an infectious cause. After controlling for the effect of all the potential confounders, the factors that showed a positive association with readmissions were hospitalizations in the year prior to the index hospitalization and discharge to either nursing home or short-term rehab. The requirement of the intensive care unit was not associated with increased readmission. High hemoglobin on discharge was associated with a reduced chance of readmission.ConclusionsReadmissions after sepsis hospitalization are common and mostly caused by infections. Several factors associated with index sepsis hospitalization can be associated with readmissions. Some of these factors are modifiable and more research is needed to see if these readmissions can be prevented.